Problem Based Learning

Marion Webb
January 2015
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By the end of the session, participants will
have
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Critically considered what problem based
learning is and how it can be used in the
classroom
Considered how PBL activities relate to
assessment
Designed a PBL activity for use in their own
teaching context
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PBL is a student-centred approach to learning
that encourages students to be self-directed,
interdependent and independent as they
attempt to solve the set problem.
Both a teaching method and an approach to
the curriculum
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To encourage students to develop skills in
accessing, interpreting and evaluating
information
To allow students to make connections
between their academic work and their own
lives
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A problem-based learning environment
emulates the workplace and develops selfdirected learners. This is preferable to a
mimetic learning environment in which
students only watch, memorize, and repeat
what they have been told.
OMMUNDSEN
Medical education at McMaster University
 Learning through problem solving more effective
for crating a body of knowledge usable in the
future
 Problem solving skills more important than
memory skills
The learning which results from the process of
working towards the understanding of, or
resolution of, a problem
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Barrowsand Tamblyn 1980 Problem based
learning: an approach to Medical Education
students engage in a collaborative activity that:
makes them think
makes them ask questions
activates prior knowledge
tests their understanding
elaborates new knowledge
reinforces their understanding by speaking
provides motivation for learning
makes them practise a logical, analytical approach to
unfamiliar situations
◦ Involves
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 learning in context
 integrated learning
 collaboration
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The problem is raised at the start of the topic
before the students have been taught some
of the relevant information
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Facilitator introduces an “ill structured
problem”
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List what is known
Includes content and knowledge of others’
strengths and capabilities
Writing out the problem statement
Listing possible solutions
List actions to be taken: what do we need to
be know? What do we need to do
The Maastricht ‘Seven Step’
PBL process
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Step
Step
Step
Step
1:
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4:
Clarify terms and concepts
Define the problem(s)
Analyse the problem(s) - ”Brainstorm”
List of the analysis and possible
solutions
• Step 5: Formulate Learning Objectives
• Step 6: Collect additional information focussed
on Learning Objectives
• Step 7: Synthesise and present new
information
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List actions to be taken
Research
Possible resources
Assign tasks
"How to make a DENT in a problem: Define,
Explore, Narrow, Test."
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A 28-year-old man appears to have
osteoporosis
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Groups brainstorm possible causes:
osteoblasts, diet, vitamin D, parathyroid
hormone, growth hormone, calcitonin, kidney
function,
Each group ranks its hypotheses in order of
priority and prepares requests for more data.
(E.g., for calcium deficiency hypothesis -"What did he usually eat?")
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Student suggestions may include
Low calcium diet
Immobility
Low density of vitamin D receptors
Calcitonin deficiency
Excessive PTH
Chronic acidosis buffered by salts mobilized
from bone
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The students could now be told that the
man's lumbar spine density is 3.1 standard
deviations below the average age-matched
healthy female (osteoporosis = 2.5+ SD), his
height is 204 cm, his left middle finger is 10
cm, and knee films show open epiphyses.
(The students should now be able to figure
out that the man may still be growing at age
28).
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A Case of a Confused Person
A 58-year-old woman experienced attacks of
confusion: she would repeat the same question
30 times even though it was answered for her
each time. [New England Journal of Medicine
315:1209-19.] This is a good introductory case,
as the students are able to generate a wide range
of ideas: Alzheimer's Disease, trauma, alcohol
abuse, atherosclerosis, arrhythmia, hypotension,
cancer, epilepsy, diabetes, hypocalcemia,
emphysema, dehydration, hypoglcemia, stroke,
etc.
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Students will ask the circumstances of the
woman's attacks (e.g., "Following alcohol
consumption?") When the students learn that
the attacks occurred in the late afternoon,
they will likely focus on diet and blood sugar.
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The student groups can now brainstorm and
investigate possible causes of the low blood
glucose: glucagon deficiency, insulin
poisoning, anorexia nervosa, extreme
exercise, etc. They may ask for an x-ray
image of her abdomen.
The students can be assisted in identifying
the anatomy, including an abnormal mass in
the pancreas (an insulin-secreting tumour)
A PBL scenario
Ranjit Singh, 46, has just returned from the
Indian sub-continent where he visited his brother
and family for a period of one month. He lives
with his wife, their four children and his parents
in a three bedroom terraced house in the Peartree
district of Derby. He works as a waiter in a local
Indian restaurant. Recently he has started
coughing a lot, has little energy, is losing weight
and has developed a fever. He visited his GP after
he coughed up some blood and developed chest
pains. His GP suspects TB and has sent a sputum
sample for analysis and Mr Singh for a chest Xray.
Learning Objectives for the PBL scenario
Basic and clinical sciences
•Describe mechanisms and common causes of cough.
•Describe types of clinical investigations available for patients with cough.
Interpretation of CXR.
•Outline the microbiology of mycobacterium tuberculosis.
•Describe the immune response to TB, its use in diagnosis and the
tuberculin test.
•Describe clinical and pathological manifestations of TB.
•Outline the drug regimes for treating TB, their mode of action, side effects
and the problem of drug resistance.
Learning Objectives for the PBL scenario
Community and population
•Describe the epidemiology of TB, the impact of socio-economic
factors and its relation to HIV.
•Discuss the social and family issues associated with TB in the
community.
Learning Objectives for the PBL scenario
Patient and Doctor
•Describe how communication problems can be dealt
with in ethnic minorities.
•Awareness of perception of TB in Asian communities
and problems of stigmatisation.
•Dealing with issues of confidentiality versus
compulsory notification: patient autonomy.
•Describe how to ensure compliance with complex
and long-term drug regimes.
•Persuade family members to be immunised.
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Relevant context
Adults are self-motivated
Adults learn best in groups
Adults prefer ‘doing’ to being told
Active learning through posing own questions and
finding own answers: therefore student centred
Integrated learning: learning in a variety of disciplines
simultaneously
Deep learning for understanding; metacognition;
reflection; appropriate feedback; opportunities for
practice
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Loss of teacher control-teacher becomes the facilitator
Resources
Loss of content
Learning on-line
Perceptions
Training
Coverage & ‘holes’ in knowledge
Expert v. non-expert tutors
Resource-intensive
Significant start-up and maintenance costs
Demanding of staff time
Can be stressful for students and staff
Need strong commitment of faculty
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Group/individual presentation
Case based individual essay
Case based clinical care plan
Portfolio
Self-assessment
Peer assessment
Viva
Reflective journal (online)
Facilitator assessment
Report
Patchwork text
Mind map
Rolls Royce have revealed that they have a small
nuclear reprocessing plant on their premises in
a heavily populated area of Derby. It is similar
to a plant in Japan where there was a recent
accident.
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The facilitator must let the students be
responsible for their learning.
The facilitator must let the students do the
work.
The facilitator has the role of monitoring and
evaluating the discussion. Guidance is given in
the form of suggestions.
The facilitator has background information
concerning the case under discussion.
The facilitator may intervene if the students are
not working or if the activity is starting to go in
the wrong direction.
The students may ask the facilitator for advice
which can be given according to his or her
judgement.
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Design a PBL scenario that you could use in
your own teaching
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Graduates of PBL
◦ More likely to engage in CPD
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Teacher & Student satisfaction
◦ Greater for PBL
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Costs
◦ More expensive with >100 students
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Savery, J. ‘Overview of Problem-based Learning: definitions
and Distinctions’ The Interdisciplinary Journal of Problem-
based Learning • volume 1, no. 1 (Spring 2006); 9-20
Maggi Savin-Baden & Claire Howell Major(2004).
Foundations of Problem-based Learning Open University Press.
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David Boud and Grahame Feletti Eds 1997.
The challenge of Problem Based Learning Kogan Page Open
University Press.
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